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Peters S, Undem K, Solovieva S, Selander J, Schlünssen V, Oude Hengel KM, Albin M, Ge CB, Kjellberg K, McElvenny DM, Gustavsson P, Kolstad HA, Würtz AML, Brinchmann BC, Broberg K, Fossum S, Bugge M, Christensen MW, Ghosh M, Christiansen DH, Merkus SL, Lunde LK, Viikari-Juntura E, Dalbøge A, Falkstedt D, Willert MV, Huss A, Würtz ET, Dumas O, Iversen IB, Leite M, Cramer C, Kirkeleit J, Svanes C, Tinnerberg H, Garcia-Aymerich J, Vested A, Wiebert P, Nordby KC, Godderis L, Vermeulen R, Pronk A, Mehlum IS. Narrative review of occupational exposures and noncommunicable diseases. Ann Work Expo Health 2024; 68:562-580. [PMID: 38815981 PMCID: PMC11229329 DOI: 10.1093/annweh/wxae045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 05/09/2024] [Indexed: 06/01/2024] Open
Abstract
OBJECTIVE Within the scope of the Exposome Project for Health and Occupational Research on applying the exposome concept to working life health, we aimed to provide a broad overview of the status of knowledge on occupational exposures and associated health effects across multiple noncommunicable diseases (NCDs) to help inform research priorities. METHODS We conducted a narrative review of occupational risk factors that can be considered to have "consistent evidence for an association," or where there is "limited/inadequate evidence for an association" for 6 NCD groups: nonmalignant respiratory diseases; neurodegenerative diseases; cardiovascular/metabolic diseases; mental disorders; musculoskeletal diseases; and cancer. The assessment was done in expert sessions, primarily based on systematic reviews, supplemented with narrative reviews, reports, and original studies. Subsequently, knowledge gaps were identified, e.g. based on missing information on exposure-response relationships, gender differences, critical time-windows, interactions, and inadequate study quality. RESULTS We identified over 200 occupational exposures with consistent or limited/inadequate evidence for associations with one or more of 60+ NCDs. Various exposures were identified as possible risk factors for multiple outcomes. Examples are diesel engine exhaust and cadmium, with consistent evidence for lung cancer, but limited/inadequate evidence for other cancer sites, respiratory, neurodegenerative, and cardiovascular diseases. Other examples are physically heavy work, shift work, and decision latitude/job control. For associations with limited/inadequate evidence, new studies are needed to confirm the association. For risk factors with consistent evidence, improvements in study design, exposure assessment, and case definition could lead to a better understanding of the association and help inform health-based threshold levels. CONCLUSIONS By providing an overview of knowledge gaps in the associations between occupational exposures and their health effects, our narrative review will help setting priorities in occupational health research. Future epidemiological studies should prioritize to include large sample sizes, assess exposures prior to disease onset, and quantify exposures. Potential sources of biases and confounding need to be identified and accounted for in both original studies and systematic reviews.
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Affiliation(s)
- Susan Peters
- Institute for Risk Assessment Sciences, Utrecht University, Yalelaan 2, 3584 CM Utrecht, the Netherlands
| | - Karina Undem
- National Institute of Occupational Health (STAMI), Gydas vei 8, 0363 Oslo, Norway
| | - Svetlana Solovieva
- Finnish Institute of Occupational Health, P.O. Box 40 FI-00032 TYÖTERVEYSLAITOS, Finland
| | - Jenny Selander
- Institute of Environmental Medicine, Karolinska Institutet, Box 210, SE-171 77 Stockholm, Sweden
| | - Vivi Schlünssen
- Department of Public Health, Research Unit for Environment, Occupation and Health, Danish Ramazzini Centre, Aarhus University, Bartholins Allé 2 DK-8000 Aarhus, Denmark
| | - Karen M Oude Hengel
- Netherlands Organisation for Applied Scientific Research TNO, Princetonlaan 6 3584 CB Utrecht, the Netherlands
| | - Maria Albin
- Institute of Environmental Medicine, Karolinska Institutet, Box 210, SE-171 77 Stockholm, Sweden
| | - Calvin B Ge
- Netherlands Organisation for Applied Scientific Research TNO, Princetonlaan 6 3584 CB Utrecht, the Netherlands
| | - Katarina Kjellberg
- Institute of Environmental Medicine, Karolinska Institutet, Box 210, SE-171 77 Stockholm, Sweden
- Centre for Occupational and Environmental Medicine, Region Stockholm, Torsplan, Solnavägen 4, 113 65 Stockholm, Sweden
| | - Damien M McElvenny
- Institute of Occupational Medicine, Research Ave N, Currie EH14 4AP, Edinburgh, United Kingdom
- Centre for Occupational and Environmental Health, University of Manchester, Oxford Rd, Manchester M13 9PL, United Kingdom
| | - Per Gustavsson
- Institute of Environmental Medicine, Karolinska Institutet, Box 210, SE-171 77 Stockholm, Sweden
| | - Henrik A Kolstad
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99. DK-8200 Aarhus, Denmark
| | - Anne Mette L Würtz
- Department of Public Health, Research Unit for Environment, Occupation and Health, Danish Ramazzini Centre, Aarhus University, Bartholins Allé 2 DK-8000 Aarhus, Denmark
| | - Bendik C Brinchmann
- National Institute of Occupational Health (STAMI), Gydas vei 8, 0363 Oslo, Norway
| | - Karin Broberg
- Institute of Environmental Medicine, Karolinska Institutet, Box 210, SE-171 77 Stockholm, Sweden
| | - Stine Fossum
- National Institute of Occupational Health (STAMI), Gydas vei 8, 0363 Oslo, Norway
| | - Merete Bugge
- National Institute of Occupational Health (STAMI), Gydas vei 8, 0363 Oslo, Norway
| | - Mette Wulf Christensen
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99. DK-8200 Aarhus, Denmark
| | - Manosij Ghosh
- Department of Public Health and Primary Care, Centre for Environment & Health, KU Leuven, Kapucijnenvoer 7, box 7001 3000 Leuven, Belgium
| | - David Høyrup Christiansen
- Centre of Elective surgery, Region Hospital Silkeborg, Department of Clinical Medicine, Aarhus University, Falkevej 3. 8600 Silkeborg, Denmark
| | - Suzanne L Merkus
- National Institute of Occupational Health (STAMI), Gydas vei 8, 0363 Oslo, Norway
| | - Lars-Kristian Lunde
- National Institute of Occupational Health (STAMI), Gydas vei 8, 0363 Oslo, Norway
| | - Eira Viikari-Juntura
- Finnish Institute of Occupational Health, P.O. Box 40 FI-00032 TYÖTERVEYSLAITOS, Finland
| | - Annett Dalbøge
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99. DK-8200 Aarhus, Denmark
| | - Daniel Falkstedt
- Institute of Environmental Medicine, Karolinska Institutet, Box 210, SE-171 77 Stockholm, Sweden
| | - Morten Vejs Willert
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99. DK-8200 Aarhus, Denmark
| | - Anke Huss
- Institute for Risk Assessment Sciences, Utrecht University, Yalelaan 2, 3584 CM Utrecht, the Netherlands
| | - Else Toft Würtz
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99. DK-8200 Aarhus, Denmark
| | - Orianne Dumas
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d’Épidémiologie respiratoire intégrative, CESP, 94807, Villejuif, France
| | - Inge Brosbøl Iversen
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99. DK-8200 Aarhus, Denmark
| | - Mimmi Leite
- National Institute of Occupational Health (STAMI), Gydas vei 8, 0363 Oslo, Norway
| | - Christine Cramer
- Department of Public Health, Research Unit for Environment, Occupation and Health, Danish Ramazzini Centre, Aarhus University, Bartholins Allé 2 DK-8000 Aarhus, Denmark
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99. DK-8200 Aarhus, Denmark
| | - Jorunn Kirkeleit
- National Institute of Occupational Health (STAMI), Gydas vei 8, 0363 Oslo, Norway
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Årstadveien 17 Block D 5009 Bergen, Norway
| | - Cecilie Svanes
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Årstadveien 17 Block D 5009 Bergen, Norway
- Department of Occupational Medicine, Haukeland University Hospital, P.O box 1400 5021 Bergen, Norway
| | - Håkan Tinnerberg
- Institute of Environmental Medicine, Karolinska Institutet, Box 210, SE-171 77 Stockholm, Sweden
- School of Public Health and Community Medicine, Gothenburg University, Huvudbyggnad Vasaparken, Universitetsplatsen 1, 405 30, Gothenburg, Sweden
| | - Judith Garcia-Aymerich
- Barcelona Institute for Global Health (ISGlobal), C/ Doctor Aiguader 88, 08003 Barcelona, Spain
- Universitat Pompeu Fabra (UPF), carrer de la Mercè 12, 08002 Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Av. Monforte de Lemos 3-5, 28029 Madrid, Spain
| | - Anne Vested
- Department of Public Health, Research Unit for Environment, Occupation and Health, Danish Ramazzini Centre, Aarhus University, Bartholins Allé 2 DK-8000 Aarhus, Denmark
| | - Pernilla Wiebert
- Institute of Environmental Medicine, Karolinska Institutet, Box 210, SE-171 77 Stockholm, Sweden
- Centre for Occupational and Environmental Medicine, Region Stockholm, Torsplan, Solnavägen 4, 113 65 Stockholm, Sweden
| | | | - Lode Godderis
- Department of Public Health and Primary Care, Centre for Environment & Health, KU Leuven, Kapucijnenvoer 7, box 7001 3000 Leuven, Belgium
| | - Roel Vermeulen
- Institute for Risk Assessment Sciences, Utrecht University, Yalelaan 2, 3584 CM Utrecht, the Netherlands
| | - Anjoeka Pronk
- Netherlands Organisation for Applied Scientific Research TNO, Princetonlaan 6 3584 CB Utrecht, the Netherlands
| | - Ingrid Sivesind Mehlum
- National Institute of Occupational Health (STAMI), Gydas vei 8, 0363 Oslo, Norway
- Institute of Health and Society, University of Oslo, Kirkeveien 166, 0450 Oslo, Norway
- Department of Occupational and Environmental Medicine, Bispebjerg and Frederiksberg Hospitals, Copenhagen, Bispebjerg Bakke 23, DK-Copenhagen 2400 NV, Denmark
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5 1353 Copenhagen, Denmark
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Rodríguez-Carrillo A, Verheyen VJ, Van Nuijs ALN, Fernández MF, Remy S. Brain-derived neurotrophic factor (BDNF): an effect biomarker of neurodevelopment in human biomonitoring programs. FRONTIERS IN TOXICOLOGY 2024; 5:1319788. [PMID: 38268968 PMCID: PMC10806109 DOI: 10.3389/ftox.2023.1319788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 12/13/2023] [Indexed: 01/26/2024] Open
Abstract
The present narrative review summarizes recent findings focusing on the role of brain-derived neurotrophic factor (BDNF) as a biomarker of effect for neurodevelopmental alterations during adolescence, based on health effects of exposure to environmental chemical pollutants. To this end, information was gathered from the PubMed database and the results obtained in the European project Human Biomonitoring for Europe (HBM4EU), in which BDNF was measured at two levels of biological organization: total BDNF protein (serum) and BDNF gene DNA methylation (whole blood) levels. The obtained information is organized as follows. First, human biomonitoring, biomarkers of effect and the current state of the art on neurodevelopmental alterations in the population are presented. Second, BDNF secretion and mechanisms of action are briefly explained. Third, previous studies using BDNF as an effect biomarker were consulted in PubMed database and summarized. Finally, the impact of bisphenol A (BPA), metals, and non-persistent pesticide metabolites on BDNF secretion patterns and its mediation role with behavioral outcomes are addressed and discussed. These findings were obtained from three pilot studies conducted in HBM4EU project. Published findings suggested that exposure to some chemical pollutants such as fine particle matter (PM), PFAS, heavy metals, bisphenols, and non-persistent pesticides may alter circulating BDNF levels in healthy population. Therefore, BDNF could be used as a valuable effect biomarker to investigate developmental neurotoxicity of some chemical pollutants.
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Affiliation(s)
- Andrea Rodríguez-Carrillo
- VITO Health, Flemish Institute for Technological Research (VITO), Mol, Belgium
- Toxicological Centre, University of Antwerp, Universiteitsplein, Wilrijk, Belgium
| | - Veerle J. Verheyen
- VITO Health, Flemish Institute for Technological Research (VITO), Mol, Belgium
| | | | - Mariana F. Fernández
- Biomedical Research Center and School of Medicine, Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), University of Granada, Granada, Spain
| | - Sylvie Remy
- VITO Health, Flemish Institute for Technological Research (VITO), Mol, Belgium
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Yuzbasioglu D, Mamur S, Avuloglu-Yilmaz E, Erikel E, Celebi-Keskin A, Unal F. Evaluation of the genotoxic and antigenotoxic effects of exopolysaccharide pullulan in human lymphocytes in vitro. MUTATION RESEARCH-GENETIC TOXICOLOGY AND ENVIRONMENTAL MUTAGENESIS 2021; 870-871:503391. [PMID: 34583820 DOI: 10.1016/j.mrgentox.2021.503391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 08/05/2021] [Accepted: 08/09/2021] [Indexed: 10/20/2022]
Abstract
Pullulan is a biocompatible and water-soluble exo-polysaccharide produced by primary strains of the fungus Aureobasidium pullulans. It is frequently used in the pharmaceutical and food industries. In this study, possible cytotoxic effect of pullulan was assessed using the MTT assay in the human breast cancer (MCF-7) cell line. Micronucleus (MN), micronucleus-FISH (MN-FISH), random amplified polymorphic DNA (RAPD-PCR), and comet assays were used to investigate genotoxic and antigenotoxic effects of pullulan against mitomycin C (MMC) (at MN assay) and hydrogen peroxide (at comet assay) in human lymphocytes. Antigenotoxicity was determined using two different applications: 1 h pretreatment and simultaneous treatment. In the MTT assay, pullulan significantly reduced the cell viability at 15.6-2000 μg/mL compared to the control. No significant alterations in MN rates were found in human lymphocytes treated with different concentrations of pullulan compared to the control. In contrast, co-treatment of pullulan and MMC decreased the frequency of MN in almost all the treatment concentrations and durations compared to the MMC. No significant change was observed in the frequency of the centromere-positive C + or negative C- MNi compared to the positive control. In comet assay, pullulan did not affect comet tail intensity compared to the negative control. On the contrary, pullulan in combination with H2O2 significantly decreased tail intensity at almost all the concentrations compared to the positive control. The changes occurring in RAPD-PCR profiles following pullulan treatments included an increase or decrease in band intensity and gain or loss of bands. These results indicate that exopolysaccharide Pullulan is not genotoxic; moreover, it possesses a protective effect against MMC and H2O2 induced genotoxicity. In breast cancer cells, pullulan induced cytotoxic/anti-proliferative effect.
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Affiliation(s)
- Deniz Yuzbasioglu
- Genetic Toxicology Laboratory, Department of Biology, Faculty of Science, Gazi University, Ankara, Turkey.
| | - Sevcan Mamur
- Life Sciences Application and Research Center, Gazi University, Ankara, Turkey
| | | | - Esra Erikel
- Genetic Toxicology Laboratory, Department of Biology, Faculty of Science, Gazi University, Ankara, Turkey
| | - Ayten Celebi-Keskin
- Department of Bioengineering, Faculty of Engineering and Architecture, Kırıkkale University, Kırıkkale, Turkey
| | - Fatma Unal
- Genetic Toxicology Laboratory, Department of Biology, Faculty of Science, Gazi University, Ankara, Turkey
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Mitri S, Fonseca ASA, Otero UB, Tabalipa MM, Moreira JC, Sarcinelli PDN. Metabolic Polymorphisms and Clinical Findings Related to Benzene Poisoning Detected in Exposed Brazilian Gas-Station Workers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015. [PMID: 26197327 PMCID: PMC4515729 DOI: 10.3390/ijerph120708434] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Benzene is a ubiquitous environmental pollutant and an important industrial chemical present in both gasoline and motor vehicle emissions. Occupational human exposure to benzene occurs in the petrochemical and petroleum refining industries as well as in gas-station workers, where it can lead to benzene poisoning (BP), but the mechanisms of BP are not completely understood. In Brazil, a significant number of gas-station service workers are employed. The aim of the present study was to evaluate alterations related to BP and metabolic polymorphisms in gas-station service workers exposed to benzene in the city of Rio de Janeiro, Brazil. Occupational exposure was based on clinical findings related to BP, and metabolic polymorphisms in 114 Brazilian gas-station attendants. These workers were divided into No Clinical Findings (NCF) and Clinical Findings (CF) groups. Neutrophil and Mean Corpuscular Volume (MCV) showed a significant difference between the two study groups, and neutrophil has the greatest impact on the alterations suggestive of BP. The clinical findings revealed higher frequencies of symptoms in the CF group, although not all members presented statistical significance. The frequencies of alleles related to risk were higher in the CF group for GSTM1, GSTT1, CYP2E1 7632T > A, but lower for NQO1 and CYP2E1 1053C > T genotypes. Moreover, an association was found between GSTM1 null and alterations related to BP, but we did not observe any effects of other polymorphisms. Variations in benzene metabolizing genes may modify benzene toxicity and should be taken into consideration during risk assessment evaluations.
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Affiliation(s)
- Simone Mitri
- Toxicology Laboratory, Center for Studies of Worker's Health and Human Ecology, Oswaldo Cruz Foundation, Rio de Janeiro 21041-210, Brazil.
| | - Antônio Sérgio Almeida Fonseca
- Medical Ambulatory, Center for Studies of Worker's Health and Human Ecology, Oswaldo Cruz Foundation, Rio de Janeiro 21041-210, Brazil.
| | - Ubirani Barros Otero
- Technical Unit of Occupational Exposure, Environmental and Cancer, Prevention and Surveillance Coordination, National Cancer Institute, Rio de Janeiro 20230-130, Brazil.
| | - Marianne Medeiros Tabalipa
- Technical Unit of Occupational Exposure, Environmental and Cancer, Prevention and Surveillance Coordination, National Cancer Institute, Rio de Janeiro 20230-130, Brazil.
| | - Josino Costa Moreira
- Toxicology Laboratory, Center for Studies of Worker's Health and Human Ecology, Oswaldo Cruz Foundation, Rio de Janeiro 21041-210, Brazil.
| | - Paula de Novaes Sarcinelli
- Toxicology Laboratory, Center for Studies of Worker's Health and Human Ecology, Oswaldo Cruz Foundation, Rio de Janeiro 21041-210, Brazil.
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Liu Z, Xu Y, Long J, Guo K, Ge C, Du R. microRNA-218 suppresses the proliferation, invasion and promotes apoptosis of pancreatic cancer cells by targeting HMGB1. Chin J Cancer Res 2015; 27:247-57. [PMID: 26157321 DOI: 10.3978/j.issn.1000-9604.2015.04.07] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 03/24/2015] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To detect the expression profiles of microRNA-218 (miR-218) in human pancreatic cancer tissue (PCT) and cells and their effects on the biological features of human pancreatic cancer cell line PANC-1 and observe the effect of miR-218 on the expression of the target gene high mobility group box 1 (HMGB1), with an attempt to provide new treatment methods and strategies for pancreatic cancer. METHODS The expressions of miR-218 in PCT and normal pancreas tissue as well as in various pancreatic cancer cell lines including AsPC-1, BxPC-3, and PANC-1 were determined with quantitative real-time reverse transcription polymerase chain reaction (qRT-PCR). The change of miR-218 expression in PANC-1 cells was detected using qRT-PCT after the transfection of miR-218 mimic for 48 h. Cell Counting Kit-8 (CCK-8) was applied for detecting the effect of miR-218 on the activity of PANC-1 cells. The effects of miR-218 on the proliferation and apoptosis of PANC-1 cells were analyzed using the flow cytometry. The effect of miR-218 on the migration of PANC-1 cells was detected using the Trans-well migration assay. The HMGB1 was found to be a target gene of miR-218 by luciferase reporter assay, and the effect of miR-218 on the expression of HMGB1 protein in cells were determined using Western blotting. RESULTS As shown by qRT-PCR, the expressions of miR-218 in PCT and in pancreatic cancer cell line significantly decreased when compared with the normal pancreatic tissue (NPT) (P<0.01). Compared with the control group, the miR-218 expression significantly increased in the PANC-1 group after the transfection of miR-218 mimic for 48 h (P<0.01). Growth curve showed that the cell viability significantly dropped after the overexpression of miR-218 in the PANC-1 cells for two days (P<0.05). Flow cytometry showed that the S-phase fraction significantly dropped after the overexpression of miR-218 (P<0.01) and the percentage of apoptotic cells significantly increased (P<0.01). As shown by the Trans-well migration assay, the enhanced miR-218 expression was associated with a significantly lower number of cells that passed through a Transwell chamber (P<0.01). Luciferase reporter assay showed that, compared with the control group, the relative luciferase activity significantly decreased in the miR-218 mimic group (P<0.01). As shown by the Western blotting, compared with the control group, the HMGB1 protein expression significantly decreased in the PANC-1 group after the transfection of miR-218 mimic for 48 h (P<0.01). CONCLUSIONS The miR-218 expression decreases in human PCT and cell lines. miR-218 can negatively regulate the HMGB1 protein expression and inhibit the proliferation and invasion of pancreatic cancer cells. A treatment strategy by enhancing the miR-218 expression may benefit the patients with pancreatic cancer.
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Affiliation(s)
- Zhe Liu
- 1 Department of Pancreatic Surgery, First Hospital of China Medical University, Shenyang 110000, China ; 2 Department of Otorhinolaryngology, Fengtian Hospital, Shenyang Medical University, Shenyang 110024, China
| | - Yuanhong Xu
- 1 Department of Pancreatic Surgery, First Hospital of China Medical University, Shenyang 110000, China ; 2 Department of Otorhinolaryngology, Fengtian Hospital, Shenyang Medical University, Shenyang 110024, China
| | - Jin Long
- 1 Department of Pancreatic Surgery, First Hospital of China Medical University, Shenyang 110000, China ; 2 Department of Otorhinolaryngology, Fengtian Hospital, Shenyang Medical University, Shenyang 110024, China
| | - Kejian Guo
- 1 Department of Pancreatic Surgery, First Hospital of China Medical University, Shenyang 110000, China ; 2 Department of Otorhinolaryngology, Fengtian Hospital, Shenyang Medical University, Shenyang 110024, China
| | - Chunlin Ge
- 1 Department of Pancreatic Surgery, First Hospital of China Medical University, Shenyang 110000, China ; 2 Department of Otorhinolaryngology, Fengtian Hospital, Shenyang Medical University, Shenyang 110024, China
| | - Ruixia Du
- 1 Department of Pancreatic Surgery, First Hospital of China Medical University, Shenyang 110000, China ; 2 Department of Otorhinolaryngology, Fengtian Hospital, Shenyang Medical University, Shenyang 110024, China
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